Extended Spectrum Betalactamase Detection in Enterobacteriaceae Family Strains
Abstract
The high incidence of infectious diseases and the rise of antibiotic-resistant enterobacteria represent a great medical problem today, and the Extended Spectrum Betalactamase (ESBL)-producing strains are an example of this phenomenon. In order to determine the production of ESBL in strains pertaining to the Enterobacteria family, isolated in the Bacteriological Reference Center at Maracaibo’s University Hospital from January 2006-December 2007, 3883 strains of enterobacteria were analyzed, distributed among 14 different species. To detect ESBL, the Kirby-Baüer test was used as a preliminary method, following the CLSI guidelines; additionally, confirmatory tests such as double disc synergy, the combined disc and E-test ESBL methods were used. Of all the enterobacteria studied, 951 (24.49%) were ESBL producers. K. oxytoca (43.33%), K. pneumoniae (40.10%), and Enterobacter cloacae (31.54%) were the microorganisms with greater ESBL production. When correlating ESBL production with the patient services, a statistically significant association (p0.05) between ESBL production and the ICU was detected. These results reflect that excessive antibiotic use produces the appearance and dissemination of resistance.
References
(1) Forero J. Betalactamasa de Espectro Extendido en Pediatría. Pediatría 2002 37(4): 12-15.
(2) Washington JA. Functions and activities of the Area Committee on Microbiology of the National Committee for Clinical Laboratory Standards. Clin Microbiol Rev 1991;4(2): 150-155.
(3) Finch RG. Antibiotic resistance. J Antimicrob Chemother 1998 (2):125-8.
(4) Hart CA. Antibiotic resistance: an increasing problem? BMJ 1998 25;316(7140):1255-6.
(5) Acar JF, Goldstein FW. Consequences of increasing resistance to antimicrobial agents. Clin Infect Dis 1998 ;27 Suppl 1:S125-S130
(6) Bush K, Jacoby GA, Medeiros AA. A functional classification scheme for betalactamases and its correlation with molecular structure. Antimicrob Agents Chemother 1995; 39(6):1211-33.
(7) Bush K, Miller GH. Bacterial enzymatic resistance: -lactamases and aminoglycosidemodifying enzymes. Current Opinion in Microbiology 1998; 1(5):509-515.
(8) Camacho L, Perozo-Mena A, Castellano-González M, Bermúdez E, Haris B. Métodos fenotípicos para la detección de betalactamasas de espectro extendido en cepas de Escherichia coli y Klebsiella pneumoniae. Revista de la Sociedad Venezolana de Microbiología 2003; 24:98-103.
(9) Hernandez JR, Pascual A, Canton R, Martinez-Martinez L. Extended-spectrum
beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in spanish hospitals (GEIH-BLEE Project 2002). Enferm Infecc Microbiol Clin 2003;21(2):77-82.
(10) Medeiros AA. Evolution and dissemination of beta-lactamases accelerated by generations of beta-lactam antibiotics. Clin Infect Dis 1997;24 Suppl 1:S19-S45.
(11) García P. Resistencia Bacteriana en Chile. Revista Chilena de Infectología 2008;20(1): S11-S23.
(12) Perozo-Mena A, Castellano-González M, Ginestre-Pérez M, Rincón-Villalobos G,
Harris-Reyes B. Caracterización Molecular y Detección de Betalactamasas de Espectro Extendido en Cepas de E. coli y K. pneumoniae Aisladas en unidades de Cuidados Intensivos de un Hospital Universitario. Kasmera 2008; 35(2):89-106.
(13) Sandrea-Toledo L, Paz-Montes A, Piña-Reyes E, Perozo-Mena A. Enterobacterias
Productoras de B-Lactamasas de Espectro Extendido Aisladas de Hemocultivos en un
Hospital Universitario. Kasmera 2008;35(1): 15-25.
(14) Instituto Nacional De Higiene Rafael Rangel, Ministerio de Salud y Desarrollo Social. II Curso de actualización en la Resistencia a los Antimicrobianos y XVI Curso latinoamericano de Actualización Antimicrobiana. 2005. Caracas Venezuela.
(15) Livermore DM, Brown DFJ. Detection of B-lactamase-mediated resistance. J Antimicrob Chemother 2001;48 (suppl 1): 59-64.
(16) Carretto E, Barbarini D, Capra F, Bolongaro A, Braschi A, Marone P. Extended spectrum B-lactamase-producing Enterobacteria in an Italian intensive Care Unit Clinical and Terapeutics remarks. Journal of Chemotherapy 2004;16(2):145-150.
(17) Clinical and Laboratory Standards Institute. Performance standards for Antimicrobial Susceptibility Testing: Eighteenth Informational Supplement. M100 S18. 2008.
(18) Dos Santos A, Rodrigues J, Bronharo M, Silva H. Avaliçáo da acurácia de testes laboratoriais para detecçáo de amostras de Klebsiella pneumoniae produtora de betalactamase de espectro estendido. Jornal Brasileiro do Patologia e Medicina Laboratorial 2003;39(4):301-8.
(19) Carter MW, Oakton KJ, Warner M, Livermore DM. Detection of Extended-Spectrum beta -Lactamases in Klebsiellae with the Oxoid Combination Disk Method. J Clin Microbiol 2000; 38(11):4228-32.
(20) Peixoto A, Pires D, Da Silva F, Barth L. Extended-spectrum beta-lactamase in Klebsiella spp and Escherichia coli obtained in a Brazilian teaching hospital; Detection, prevalence and molecular typing. Brazilian Journal of Microbiology 2003;34:344-8.
(21) Spanu T, Luzzaro F, Perilli M, Amicosante G, Toniolo A, Fadda G. Occurrence of
Extended-Spectrum -Lactamases in Members of the Family Enterobacteriaceae in Italy: Implications for Resistance to -Lactams and Other Antimicrobial Drugs. Antimicrob Agents Chemother 2002;46(1): 196-202.
(22) Bauer A, Kirby W, Sherris J, Turck M. Antibiotics susceptibility testing by a standardize single disk method. Am J Clin Pathol 1966; 45:493-6.
(23) Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Disk Susceptibility Test: Approved Standards Ninth Edition. 2006.
(24) Jarlier V, Nicolas MH, Fournier G, Philippon A. Extended broad-spectrum betalactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns. Rev Infect Dis 1988; 10(4):867-78.
(25) Rubio A, Calderas A, Trujillo B. Betalactamasas de espectro extendido (BLEE) en cepas de Escherichia coli y Klebsiella pneumoniae aisladas de muestras del Servicio Autónomo Hospital Universitario de Maracaibo 2003. Tesis de Grado para optar al Título de Licenciado en Bioanálisis. Escuela de Bioanálisis, Facultad de Medicina. Universidad del Zulia. Pp 145.
(26) Lee K, LimJK, Yong D, Yum J, Chong Y, Okamoto R, et al. Evaluation of Efficiency of Screening Extended-Spectrum B-Lactamase- -Producing Escherichia coli and Klebsiella pneumoniae in Hospitals Where the Bacteria Are Increasingly Prevalent. J Clin Microbiol 2001;39(10):3696-9.
(27) Livermore DM. -Lactamases in laboratory and clinical resistance. Clin Microbiol Rev 1995;8(4):557-84.
(28) Lewis E, Winterberg K, Fink A. A point mutation leads to altered product specificity in –lactamase catalysis. PNAS 1997; 94(2):443-7.
(29) Krontal S, Leibovitz E, Greenwald-Maimon M, Fraser D, Dagan R. Klebsiella bacteremia in children in southern Israel (1988-1997). Infection 2002;30(3):125-31.
(30) Martínez P, Mercado M, Máttar S. Determinación de beta-lactamasas de espectro extendido en gérmenes nosocomiales del Hospital San Jerónimo, Montería. Colombia Médica 2003;34(4):196-205.
(31) Torres L, Gagliotta V, Torres O, Benítez M, Domínguez M, Pedroza R. Betalactamasas de espectro extendido en Enterobacterias aisladas en centros de salud de Caracas. Revista de la Sociedad Venezolana de Microbiología 2006;26(2):80-8.
(32) Mammeri H, Poirel L, Nordmann P. In Vivo Selection of a Chromosomally Encoded B-Lactamase Variant Conferring Ceftazidime Resistance in Klebsiella oxytoca. Antimicrob Agents Chemother 2003; 47(12):3739-42.
(33) Fournier B, Lu CY, Lagrange PH, Krishnamoorthy R, Philippon A. Point mutation in the pribnow box, the molecular basis of beta- lactamase overproduction in Klebsiella oxytoca. Antimicrob Agents Chemother 1995;39(6):1365-8.
(34) Venezia R, Scarano F, Preston K, Steele L, Root T, Limberger R, et al. Molecular epidemiology of an SHV-5 extended-spectrum beta-lactamase in Enterobacteriaceae isolated from infants in a neonatal intensive care unit. Clin Infect Dis 2005;21:915-23.
(35) Fournier B, Roy PH, Lagrange PH, Philippon A. Chromosomal beta-lactamase genes of Klebsiella oxytoca are divided into two main groups, blaOXY-1 and blaOXY-2. Antimicrob Agents Chemother 1996;40(2): 454-9.
(36) Arakawa Y, Ohta M, Kido N, Mori M, Ito H, Komatsu T, et al. Chromosomal betalactamase of Klebsiella oxytoca, a new class A enzyme that hydrolyzes broad-spectrum beta-lactam antibiotics. Antimicrob Agents Chemother 1989;33(1):63-70.
(37) Ramos Godínez A, Hernández Pedroso W, Nodarse Hernández R, Padrón Sánchez A, De Armas Alonso E, Del Rosario Cruz L. Detección precoz de enterobacterias productoras de betalactamasas de espectro extendido en pacientes graves. Rev Cub Med Int Emerg 2006;5(1):294-301.
(38) Bermejo J, Bencomo B, Arnesi N, Lesnaberes P, Borda N, Notario R. Alta correlación entre el consumo de ciprofloxacina y la prevalencia de Klebsiella pneumoniae productora de productora de betalactamasa de espectro extendido. Rev Chil Infect 2006;23(4):316-20.
(39) Crespo M. La lectura interpretativa del antibiograma: Una herramienta para predecir la resistencia bacteriana en el laboratorio de microbiología de rutina. Colombia Médica 2002;33(4):179-93.
(40) Hernández Pedroso W, Ramos Godínez A, Nodarse Hernández R, Padrón Sánchez A, De Armans Moreno A. Resistencia bacteriana en las bacterias productoras de betalactamasas extendidas (BLEE). Rev Cub Med Int Emerg 2006; 5(1):256-64.
(41) Trucco O, Prado V, Duran, Y, y grupo PRONARES. Red de vigilancia de resistencia antimicrobiana PRONARES. Rev Chil Infect 2002; 19(Suppl 2):s140-s148.
(42) Gobernado M. Betalactamasas de espectro extendido en aumento. Servicio de Microbiologóa Hospital Universitario La Fe, Valencia. Rev Esp Quim, 2005; 18(2):115-7.
Copyright (c) 2009 Armindo José Perozo Mena, Maribel Josefina Castellano González
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Kasmera journal is registered under a Creative Commons an Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0), available at: https://creativecommons.org/licenses/by-nc-sa/4.0/deed.en; which guarantees the freedom to share-copy and redistribute the material in any medium or format and adapt-remix, transform and build from the material, provided that the name of the authors, the Department of Infectious and Tropical Diseases, Zulia´s University and Kasmera Journal, you must also provide a link to the original document and indicate if changes have been made.
The Department of Infectious and Tropical Diseases, University of Zulia and Kasmera Journal do not retain the rights to published manuscript and the contents are the sole responsibility of the authors, who retain their moral, intellectual, privacy and publicity rights. The guarantee on the intervention of the manuscript (revision, correction of style, translation, layout) and its subsequent dissemination is granted through a license of use and not through a transfer of rights, which represents the Kasmera Journal and Department Infectious Diseases, University of Zulia are exempt from any liability that may arise from ethical misconduct by the authors.
Kasmera is considered a green SHERPA/RoMEO journal, that is, it allows self-archiving of both the pre-print (draft of a manuscript) and the post-print (the corrected and peer-reviewed version) and even the final version (layout as it will be published in the journal) both in personal repositories and in institutional and databases.
_pequeño1.png)
_pequeña.png)
_pequeña.png)
_pequeña.jpg)
